Bowel obstruction (intestinal obstruction)

Bowel obstruction (intestinal obstruction)

    * Introduction
    * Causes
    * Signs and symptoms
    * Diagnosis
    * Treatment
Intestinal obstruction is the most common surgical disorder of the small intestine and one of the most frequent diseases of the colon, bowel constiind in stopping. Symptoms include constipation, vomiting, abdominal pain and lack of gas transit. Etiological there are two main types: the mechanical and paralytic occlusion. Paralytic occlusion may occur in inflammatory bowel thin or thick, but it may occur reflexively in renal colic, they get into remission with medication. Mechanical obstruction is given by the existence of a physical obstacle in the way of bowel and advertising in most cases interbentie surgery. Intestinal obstruction, requiring surgery or not, is responsible for 20% of hospitalizations in emergency in general ghirurgie services. It meets all ages. The new-born is responsible for 10% of deaths by birth defects and hernias. The adult incidence increases with age, clamps and hernias being the main causes. It is more common than 50 years, and meets and over 70 years by the increasing incidence of digestive cancers and diverticulitelor colic. Clamps, diverticula, hernias and cancer are responsible for 80% of intestinal obstructions in adults. In occlusion, the intestinal contents can not progress normally to the rectum, due to intrinsic or extrinsic obstacles located on the small intestine or colon, or mechanical nature of perception works. Treatment consists of resuscitation, correction fluid and electrolyte balance, and nasal-gastric decompression to treat temporary blockage and to prevent vomiting and aspiration, followed by bowel resection segment concerned.
Pathology
The events caused by occlusion of the small intestine are: Hiperstaltismul react- -Distention by fluid accumulation and Gaza Bacterial-proliferation Content-vascular transudate variable absorption of bacterial toxins Functional extracellular volume-reduction trend and hypovolemic shock. Hiperstaltismul is given by increasing the intrinsic reflex activity in order to empty the bowel loop distension occlusal to protect. Inprima occlusion phase of evolution, musculatuira intestinal trying to overcome the obstacle by increasing peristalticii. Peristalsis may be highlighted in the abdominal wall inspection or drums that trigger it. In advanced stages of evolution of occlusion, due to poor energy intake and prolonged effort, intestinal smooth muscle decompensation contranctile suffer with bowel distention. In occlusal intestine accumulate large quantities of gas from swallowed air and bacterial production, and food and liquid intake of nitrogen difezarea blood. Refluate fluids on the outside, by vomiting, or stomach, intestine allow easy decompensation. They cause a decrease in extracellular volume, interstitial and plasma pronounced dehydration of the patient in a short time and hypovolemic shock Luemnul normal pressure of loops is 2-4 mm Hg, in simple occlusion and increased to 10-14 mm Hg during peristalticii at 30-60 mm Hg. A pressure over 30mm Hg da lymphatic capillary stasis and venous stasis than 60 mm Hg. Hiperpresiunea containing more than 20 mmHg after 28 hours resulting in intestinal necrosis. The accumulation of gases and liquids in ans, train abdominal distention, which limits pulmonary ventilation by raising diafragnului. This is more dangerous to the elderly, in which respiratory function is reduced. Another resultant distension is increased capillary permeability and impaired barrier function of the intestinal wall, allowing transudatia liquids, bacteria and bacterial toxins. The material in the lumen stasis occurs an exacerbation of microbial flora, capable of moving into the peritoneal cavity and cause peritonitis, which often are fatal.